Steroids and b'feeding

[~bookcase~]

Researchers have hypothesised that the administration of corticosteroids to the mother in preterm labour could be the cause of low milk supply. The corticosteroid competes with progesterone (which is inhibiting lactation during pregnancy) resulting in stimulation of the breast and causing LII to occur before delivery, with resultant poor lactation performance at term.

I've added a pole to find out what our preemie experiences are.

I went into labour at 32 weeks but was only in hospital for an hour or so before babies were born. They offered me steroids after they discovered I was 5cm+ but I declined as I knew there was not time for them to work.

Both babies had their cords cut immediately after birth and my ds never even got to see us before he was taken away. Dd got a brief cuddle and kiss.

Ds was ventilated for a short while. I swear it's because he was removed so mercilessly, with NO skin-to-skin, as after he pulled the vent out he thrived. Dd was sooo slow to get well, but she never needed ventilating, and she got the skin and comfort touch.

Anyway, sorry to go OT!! they both were on cpap for a bit, but expressing went well after the first few days and I had a good supply (they were also my 5thand6th so I'd had the benefit of b'feeding before in terms of my breast development. First time preemie mums are going to have to wait a little longer for their breasts to get the cue to lactate NOW PLEASE )

[liberal_chick]

I had two different rounds of the steriods and I had plenty of milk. I could fill up two bottles with one side during almost every pumping session!

[OGirlieMama]

I had steroids, but 2 weeks prior to giving birth. Milk supply was plentiful.

[susienjay]

I had 2 rounds of steroids about 4 weeks before my twins were born at 32 weeks. I had no supply issues at all.

I had steroid shots at 28w6d and 29w0d with my dd that was born at 29w3d. I had supply issues with her and really struggled to nurse her but I think the supply issues had more to do with PPD and personal issues at the time.

[aris99]

I was given steroids and my milk supply was close to non existant even w/domperidone. I think it might be important to include the gestational age at birth too though...my dd was born at 26 weeks and I was told "my body just wasn't prepared for the birth". Maybe it wasn't but how come the NICU refrigerator was filled w/bm from mothers w/HUGE supplies

[~bookcase~]

aris99 - yes, gestational age makes a difference, absolutely
if it's a first pregnancy or not makes a difference, and when the shots are given makes a difference too apparently.

after reading the research it made me think about informed choice again and weighing up the odds of which problems are easier to work with iyswim. so, if i was to have preemies again, God forbid, I would not personally take the steroids after 30 weeks gestation (though I'm fairly sure I will be demanding them at two *earlier* points in any future pregnancy and not leaving the hospital until I've got them )

[sunflowers]

DD was born at 27 weeks and I was producing colustrum (sp?) 6 hours later.

I received the steroids almost 1 week prior to birth and saw no initial decline in milk production. The decline came later after several weeks of no/little sleep, poor nutrition, stress, pump revulsion, ect. The supply bounced back post NICU and then some since we struggled with overproduction and OALD after dd came home.


But in the first few weeks, I could have fed several babies. My personal experience does not corelate to the hypothosis.

[Bokonon]

DS was born at 32w2d. I had the 2 rounds of steroids in the 2 days before he was born. I had a c-section with no labor (severe preeclampsia), only got to see him for a moment before he was taken away and then I wasn't allowed to visit the NICU for about 30 hours. I didn't pump until the day after delivery. I still was fortunate enough to have an oversupply!

I had the steroids with DD at 29w, and delivered at 34, another c-section with no labor. I had to limit my pumping to 6x a day because I produced massive amounts of colostrum at first, and she wasn't taking any feedings for the first few days (magnesium sulfate toxicity from my treatment). My milk came in like gangbusters 2 days postpartum, and I've been a great producer once again. I know I am very lucky to have had that experience with my milk supply!

[FiveLittleMonkeys]

I received steroids about a week before ds was born (33 weeks). I didn't struggle with supply, but it seemed to take a long time for my milk to come in - long enough that it worried me. It eventually came in just fine, and my itty bitty preemie is now 17 lbs, 9 ounces at his 6 mo. check.

[Crunchy Frog]

I didn't have any steroids and went into labor spontaneously at 33.3 weeks, and had an absolutely crappy supply. I never had enough to feed even one baby without supplementing, and had to finally throw in the towell completely at 6 1/2 months.

My babies nursed well from the first try and always had a strong latch. I just couldn't get my boobs to do much of anything.

[~bookcase~]

thank you so much for these replies

mamas who struggled with supply:
every drop your babies had was liquid gold. it sounds so corny, but it's the best medicine they got in their whole NICU/SCBU life, regardless of how much/how long they had it.

it's super to see that mamas had good experiences after steroids too.

[justmama]

I had the betamethasone shots with my first preemie(34weeks) and had latch troubles for 3 months but abundant milk. My body took an extremely long time to "warm up" to the pitocin but then I went from 5cm to 10cm and baby out in under 45minutes so the doctor barely had enough time to RUN into the room with the nicu team on his heels and catch her. She was ripped away from me before I saw her face and my milk was already soaking my hospital gown. She was on an ng tube until day 8 of life and on bottles when she came home. I pumped for her until she was 3 months old and latching reliably.
No shots with the second preemie(33weeks) and still abundant milk but no latch troubles this time. I didn't want a repeat of my previous preemie birth so I had a midwife(and also a doctor since I risked out of the birth center and delivered at the hospital) and her birth was slower and less scary and I caught her and pulled her to my chest for a kiss before I let them take her. I don't know if it was the quick bonding time or just actually SEEING my child right away or just the extra confidence in having already "been there done that" but we had no latch issues and she was exclusively nursing from day 1 of being home and nursing several times successfully in the hospital. No ng tube like her sister.

[sbrinton]

I had steriods at 29 weeks before my son was born at 31. I had a very plentiful milk supply (pumping at least 60 ounces a day by end of the first week!).

[felix23]

I had one shot less then 24 hours before my 29 weeker was born. I did have supply problems, but I think it most likely stems from the fact that due to my poor health, I wasn't really able to start pumping till almost four days after I gave birth.

[boobs4milk]

i've had three preemies with one more born at term but with threatened pre-term labor.

preemie #1: no steroids, spontaneous labor @ 35 wks, no supply issues even with a lazy nurser

preemie #2: preterm labor, bedrest for 15 wks, pprom @ 26 wks, hospitalization with meds @ 26 wks, betamethasone steroids shots @ 26 wks, 27 wks, 28 wks, 29 wks (before the dr's knew that 2 were enough), 8 min natural vag birth @ 30 wks 3 days, no supply issues, baby unable to nurse due to sensory issues

almost preemie: preterm labor, 20 wks bedrest, 17p hydroxyprogesterone shots wks 22-36, numerouis hospitalizations, betamethasone shots at 34 wks, delivered vag with augmentation (pit) @ 37 wks, no supply or latch issues

preemie #3: preterm labor, 15 wks strict bedrest, hospitalizations with meds @ 28-32 wks and 33-35 wks, 17p shots 20 wks-28 wks, 32-33wks, betamethasone shots @ 28 wks, vag delivery with augmentation (pit) @ 35 wks, latch issues but no supply issues

i've always had enough milk for 3 babies until about 3 wks ago when i had surgery and my supply nose-dived. dd was 11 wks old and we had been all on breast for 6 wks at that point.

i don't think the steroids are alone in 'causing' low supply. just the trauma of having a preemie or a sick baby in the nicu are enough to cause a woman to under produce. and i'd wager that a great many preterm births are tough as well, so more stress = less milk. i know i was a tired, stressed out, not eating right mess when my kids were in the nicu!!! i am built to make tons of milk.

[MeepyCat]

I had two betamethasone shots about three weeks before DD was born, and had no problems with supply, but I wonder if the researchers in this case had any means of separating the effects of the steroids from the effects of the pre-term birth and NICU experience.

I was at a pretty good NICU, but they had only about a dozen breastpumps and at least 40 patient beds. They had a limited supply of recliners and rocking chairs, which were moved around the unit. There were times when I wanted to pump cribside, but couldn't find a pump or a chair, and moving these things around was a major challenge in the first days after my c-section. They didn't want mothers to attempt breastfeeding with infants below 33-34 weeks GA. All of these things impact supply.

My dd was born at 32 weeks and needed three doses of surfactant to get through her first 24 hours. I would rather struggle with supply than with breathing problems.

[mama2soren]

I had a 31 weeker with 2 rounds of steroids before birth. In recovery, just an hour after his CS birth, I was already leaking through layers of hospital gowns, sheets, and blankets. I pumped nearly 2 oz of colostrum 3 hours after his birth, and always had way more milk than I ever needed!

[amydiane]

I had a 25 weeker, with shots 3-4 days before he was born. My supply was adequate, but not great. They also didn't get me a pump until about 24 hours after he was born, and I had to EP for over 2 months. We didn't get to even try BFing until he was around 35 or 36 weeks GA. Then I mostly pumped for the next month as we worked on switching over.

In comparison, my supply is soooo much better with my FT DD.

[moaningminny]

Very interesting! I had steroids one week before giving birth to my 31 weeker (water broke and she managed to stay in for another week), and my milk supply was pitifully low. Domperidone was my friend - sort of.

Interestingly enough, I also had steroids at 30 weeks with my 39 weeker, and I ended up with overactive letdown/supply.